What is the prostate?
The prostate is a gland the size of a walnut that lies below the bladder. Urine has to pass through this doughnut-shaped gland before it reaches the urethra, the tube that drains urine. As Dr Luke Powles, clinical director at Bupa Health Clinics, explains, “Your prostate may be a small gland, but it plays an important role in reproduction. Its main job is to produce the fluid part of semen which nourishes the sperm. It also produces a protein called prostate specific antigen (PSA), which is involved in turning your semen into liquid.”
 
When are you most likely to experience problems with your prostate?
From the age of 25, your prostate begins to slowly enlarge, and it’s this increase in size that can cause problems. “The risk of prostate issues increases with age,” explains Luke, “An enlarged prostate is most common in men aged over 50. In fact, around 40% of men begin to have uncomfortable symptoms due to this enlargement when they reach 50. But this doesn’t mean it’s something you should ignore in your 20s and 30s.”
 
Before you reach the age of 50, the most common prostate problem you’re likely to encounter is prostatitis, says Emma Craske, senior specialist nurse at Prostate Cancer UK. “Prostatitis, which is an infection or inflammation in the prostate, typically affects men in their 20s and 30s. The most common symptoms are pain in the pelvis and urinary symptoms, such as needing to go to the loo more frequently and urgently. There are four types of prostatitis, but the most common is known as chronic pelvic pain syndrome (CPPS). It’s not uncommon to suffer with pain and symptoms for three months or more, and symptoms can come and go over time. There has been some research to link stress, anxiety and depression with CPPS and also other chronic conditions such as IBS and chronic fatigue syndrome.”

What about prostate cancer?
Prostate cancer is rare in your 30s but the risk increases from your 40s. Symptoms of prostate enlargement affect 75% of men in their 70s and, while most cases are benign, one in eight men will develop prostate cancer. There are around 47,000 new cases and over 10,000 deaths each year. However, UK survival rates have trebled in the last 40 years and more than 80% of affected men live at least another ten years, thanks to earlier diagnosis and better treatment. You are more at risk as you age, and if you have a family history of prostate cancer, have had another cancer, are tall or overweight, or black African/Caribbean. “You may also be more at risk if you have a mother or sister who has been diagnosed with breast cancer,” adds Emma.

What symptoms should you be looking out for?
Regardless of your age, it’s important to understand that early prostate cancer doesn’t usually cause any symptoms, which is why it’s vital to look out for any warning signs. Emma explains that classic signs of prostatitis include any form of pelvic pain or the sensation that you are sitting on a golf ball. “If you feel an ache anywhere deep inside, from the belly button down to your knees over a period of three months or more, you should pop to your GP. Prostatitis can also cause burning and stinging when peeing as well as going more frequently and urgently,” she advises. Meanwhile, as you age (typically once you reach 50) you may start to develop urinary symptoms, including a weak urine stream and a feeling of incomplete emptying of your bladder. You may also need to get up a couple of times in the night to go to the loo. Emma explains these symptoms are nearly always due to benign prostate disease, as the enlarged prostate presses on your urethra. In a minority of cases, however, these same symptoms could be due to a cancerous growth in the prostate. “It’s important to know that you may have no symptoms at all in the early stage of the disease,” she stresses.
 
What should you be doing to monitor your prostate?
The prostate can’t be self-checked as it’s tucked away, deep inside the body, meaning your GP should be your first point of contact. “Although there isn’t a national screening programme, the NHS runs an informed choice programme called Prostate Cancer Risk Management,” says Luke. “There isn’t a national programme because it’s not certain the benefits of the test outweigh the risks. While there is evidence that the PSA test can reduce the risk of dying from prostate cancer, there are problems with over-diagnosis (i.e. diagnosing cancer that wouldn’t have caused any problems) and unnecessary treatment. Instead, men can make an informed choice about whether to have their PSA level checked once they are 50. You can find out more from the NHS Choices website and Patient.info.”
 
Luke adds that if you are concerned about your prostate, you can get it checked privately. “This is usually done with a blood test, which checks your PSA levels. It’s normal to have a small amount of PSA in your blood, but a higher amount of PSA could be a sign of prostate cancer or another problem with your prostate, such as an infection or inflammation.”

If your GP finds a problem, what next?
If your GP has carried out a PSA test as well as urine checks for blood and infection, they may refer you to a specialist urologist. You may need a prostate biopsy (a tissue sample taken via the rectum using a local anaesthetic), before or after a magnetic resonance scan. You may also need a bone or CT scan or X-rays, depending on your symptoms. “If you are dealing with prostatitis, an infection is usually treated with antibiotics, while bothersome symptoms from an enlarged prostate can be helped with medication. There are also various procedures which can increase the size of the urethra if needed,” Emma adds.
 
Can prostate problems affect fertility?
There is no evidence to suggest there’s a link between prostatitis and infertility, says Emma, although cancer in the prostate can affect its ability to make semen, which can result in infertility. “However, the vast majority of men with an enlarged prostate and/or prostate cancer tend to be in an older age bracket, so fertility may not be an issue at this stage. Men who would like to have children may be offered the opportunity to freeze their sperm if their recommended course of treatment may cause infertility. At the same time, there isn’t much research to suggest CPPS, the most common prostate problem in your 30s and 40s, affects fertility.”
 
In the meantime, what can you be doing to support your prostate?
While the peak age for prostate cancer diagnosis is 65 to 69, that doesn’t mean it’s something you can ignore until then. In fact, when it comes to cutting your risk of prostate cancer, you may have more control over your risk than you think. In a recent study which analysed long-term lifestyle data and cancer risk, men practising a healthy lifestyle (i.e. no smoking, moderate drinking/abstinence, BMIs maintained between 18.5 and 27.5, and 150 minutes of moderate exercise per week) reduced their risk of getting any form of cancer by a third.
 
Roberta Stringer, a naturopathic nutritionist specialising in men’s health, says tweaking your diet can also help. “Certain nutrients are known to have an impact on prostate health due to their effects on testosterone, the main hormone that controls the prostate. Tomatoes, for example, are a rich source of lycopene, an antioxidant which can lower the risk of prostate cancer and its aggression. At the same time, try to eat less animal protein – diets rich in red meat, dairy products and animal fat have been linked with the development of prostate cancer. Red meat should be avoided if possible; instead, eat plenty of plant-based proteins such as beans, flax and nuts, which all have anti-cancer properties.”


For more information, head to Bupa.co.uk and ProstateCancerUK.org. Roberta is also the founder of Dynamic Nutrition Academy, which offers supplements for men designed to support optimal hormone levels.
 

DISCLAIMER: Features published by SLMan are not intended to treat, diagnose, cure or prevent any disease. Always seek the advice of your GP or another qualified healthcare provider for any questions you have regarding a medical condition, and before undertaking any diet, exercise or other health-related programme.